面向社区的健康监护系统的研究与设计

目的：研究并设计了一种基于C/S-B/S混合架构的社区健康监护系统。方法：系统由安装在客户端的远程监护软件、社区医疗Web站点、数据库服务器组成,采用面向对象和模块化设计方法,VS2008.NET平台为开发环境,结合Windows和Web编程技术,C＋＋与C#为开发语言进行开发。结果：系统的C/S子系统经过社区医院的测试运行,实时性与交互性满足医患之间的交流与病情诊断的需要。B/S子系统实现了居民健康档案的注册,慢性病个性化以及贴心便捷的管理,并能享受到网上预约、健康评估等服务。结论：实现了居民心电、血氧等生理参数的远程监护,健康档案注册,慢性病跟踪等功能,为社区医疗的网络化、信息化的完善起到推动作用。     

Mobile computing and the quality of home care nursing practice

We investigated the effects of the introduction of mobile computing on the quality of home care nursing practice in Québec. The software, which structured and organized the nursing activities in patients' homes, was installed sequentially in nine community health centres. The completeness of the nursing notes was compared in 77 paper records (pre-implementation) and 73 electronic records (post-implementation). Overall, the introduction of the software was associated with an improvement in the completeness of the nursing notes. All 137 nurse users were asked to complete a structured questionnaire. A total of 101 completed questionnaires were returned (74% response rate). Overall, the nurses reported a very high level of satisfaction with the quality of clinical information collected. A total of 57 semi-structured interviews were conducted and most nurses believed that the new software represented a user-friendly tool with a clear and understandable structure. A postal questionnaire was sent to approximately 1240 patients. A total of 223 patients returned the questionnaire (approximately 18% response rate). Overall, patients felt that the use of mobile computing during home visits allowed nurses to manage their health condition better and, hence, provide superior care services. The use of mobile computing had positive and significant effects on the quality of care provided by home nurses.     

Traditional and Mobile Public Health Alert Communications with Health Care Providers

Objective

To systematically compare mobile (SMS) and traditional (email, FAX) communication strategies to identify which modality is most effective for communication of health alerts and advisories between public health agencies and health care providers in order to improve emergency preparedness and response.

Introduction

The effectiveness of emergency preparedness and response systems depends, in part, on the effectiveness of communication between agencies and individuals involved in emergency response, including health care providers who play a significant role in planning, event detection, response and communication with the public. Although much attention has been paid to the importance of communicating clinical data from health care providers to public health agencies for purposes of early event detection and situational awareness (e.g., BioSense) and to the need for alerting health care providers of public health events (e.g., Health Alert Networks), no studies to date have systematically identified the most effective methods of communication between public health agencies and community health care providers for purposes of public health emergency preparedness and response.The REACH (Rapid Emergency Alert Communication in Health) study is a 4-year randomized controlled trial to evaluate and compare the effectiveness of mobile (SMS) and traditional (email, FAX) communication strategies for sending public health messages to health care providers—physicians, pharmacists, nurse practitioners, physician’s assistants and veterinarians.

Methods

Providers were recruited from three sites (King County, WA; Spokane County, WA; and across the state of Montana; N=845) and randomized to receive time-sensitive public health messages via email, Fax, short message service (SMS) or to a control group that did not receive messages. For one year, alerts based on real events of public health interest were sent quarterly with follow-up telephone interviews conducted 5–10 days after the delivery date. Interviews consisted of approximately six questions that elicited information about message receipt, recall of its content and perceived credibility and trustworthiness of the message and source. In addition, provider access to online alert information and delivery success or failure was collected.

Results

Frequency of receipt, timeliness, content awareness, perceived credibility and perceived trustworthiness were measured and compared across communication delivery systems. On average 84.0% of participants were contacted in each follow-up survey following all alerts and across all three sites. Primary data analysis was designed to measure differences between the three communication groups using intent-to-treat methods. A set of secondary analyses examined the outcomes excluding providers who could not have received messages (due to incorrect contact information, known technical failures, or because providers could not receive messages by the assigned delivery message—for example, a provider without a Fax number randomized to the Fax group).We will discuss preliminary results of intent-to-treat analyses regarding rate of recall of study alert message content between traditional and mobile communications and perceived trustworthiness and credibility of message and message source by providers. In addition, we will report on frequency of accessing online alert information between traditional and mobile delivery groups.

Conclusions

There is currently no evidence-based research to guide or improve the practice of public health communication between public health agencies and health care providers before, during and after a public health emergency. Improving this communication via the use of effective media can enhance disease surveillance, which will aid in early detection and enhance case finding and situational awareness for public health emergencies. By systematically evaluating the relative effectiveness of mobile and traditional message delivery systems for emergency preparedness and response communications, the REACH study contributes to building the evidence base for novel and effective approaches to emergency communications.     

Health systems strengthening in conflict situations

Many people in Africa live in fragile states where conflicts are common. These countries are under pressure to deliver health services within their limited capacity. This paper looks at ways of strengthening health systems in conflict and post-conflict situations at a time when many African countries are emerging from conflict. The paper concludes that health systems strengthening in post-conflict situations should focus on the delivery of primary health care services using existing human resources for health, community structures, NGOs and mobile clinics while pursuing renovation of health facilities and human resources for health development in the medium and long term.     

The Health Education Centre: a new approach to professional support and development in Australia

In 1989 a new concept emerged in the provision of professionalsupport for health workers with the development of the HealthEducation Centre, Barwon South Western Region. The Barwon SouthWest Region includes Geelong (Victoria's largest regional city)and the predominantly rural south western half of the Stateto the South Australian border. Unique in Victoria (and Australia),it is funded by the Health Department and recognizes the needfor ongoing support for health workers in a changing and complexfield. The Centre offers assistance to all health workers (witha particular focus on workers in small hospitals, communityhealth centres and community based agencies) through on goingprogramme development and consultancy, in- services, networkingand information. This paper examines the Health Education Centre's approach toits role. Beginning with an overview of the changing role ofhealth care and health workers, it explores the impact of newpolicy directions and the inadequacy of workers' educationalbackground to meet the challenges that these policies present,resulting in an implementation gap between policy and practice.The paper advocates the adoption of a professional model forprofessional development rather than a technical one, and suggestthat health workers need to be exposed to different educationalexperiences in order to close the implementation gap betweenpolicy and practice. The paper concludes with an overview ofthe Health Education Centre's response to its target group andoutlines its model of professional development which is basedon the principles and strategies advocated by the Ottawa Charter.     

Bridging the Communication Gap: Successes and Challenges of Mobile Phone Technology in a Health and Demographic Surveillance System in Northern Nigeria

Maternal and child health indicators are generally poor in Nigeria with the northern part of the country having the worst indicators than the southern part. Efforts to address maternal and health challenges in Nigeria include, among others, improvement in health and management information systems. We report on the experience of mobile phone technology in supporting the activities of a health and demographic surveillance system in northern Nigeria. Our experience calls for the need for the Nigerian Government, the mobile network companies, and the international community at large to consolidate their efforts in addressing the mobile network coverage and power supply challenges in order to create an enabling environment for socio-economic development particularly in rural and disadvantaged areas. Unless power and mobile network challenges are addressed, health interventions that rely on mobile phone technology will not have a significant impact in improving maternal and child health.     

移动健康监护系统

本文描述了移动健康监护系统的发展现状,对移动健康监护系统存在的主要问题及今后的发展方向进行了讨论。     

医疗体系中外展社区服务的重要性

院外医护服务在香港医疗体系中起着重要作用。院外医护医疗工作者如社区护士、家庭服务志愿者和社会工作者来自于社区的助人网络。 院外医护人员的优点是: (1)延长医护服务的连续性;(2)缓解病人的心理压力;(2)监察病情;(4)推广健康教育知识。     

Health and development

Health is determined by a complex of factors. Health status depends on development. Prevention of disease is as important as cure. There are difficulties with integration of health care and development, but no all are scientific and technical. Integrated health action is often done in the form of pilot studies, but they are likely to fail. To air for health through development is an ethical and political necessity as well as an economic one. Health expenditure cannot be increased without limit. Health status is not determined solely by the development of public health services. Public health leaders should help with development planning activities. Priority should be given to preventive medicine, and rural populations. Multidisciplinary health workers should be trained. Research should be applied to the specific problems of African health. The concept of health care integrated with development is being promoted by the UN development Program (UNDP) associated with the World Health Organization (WHO). UNDP hopes to strengthen the links between its Regional Office for Africa and the WHO Regional Office for Africa. A WHO Liaison Officer at the local office of UNDP in Brazzaville has been established. The development of a broader strategy on the general health and development theme would involve health workers in programs. The health sector can no longer maintain its earlier performance, or even sustain past achievements. Primary health care programs should be adequately financed.     

Mind the Gap: Assessing the Disconnect Between Postpartum Health Information Desired and Health Information Received

IntroductionSeeking and receiving health information are critical aspects of prenatal and postpartum care; however, many informational sources lack postpartum content. This study explores the gaps between information desired and information received postpartum and identifies the sources women use for health information seeking, with an emphasis on emergent online and mobile phone-based resources.MethodsParticipants were recruited from our community partners’ client base for a cross-sectional study. Mothers (n = 77) of a child 48 months or younger completed a survey on health information seeking, health information needs, and technology use. Postpartum health information gaps were defined as topics about which a participant indicated that she wanted information, but did not receive information. Bivariate analyses assessed the association between demographic characteristics, sources of health information used during pregnancy, and postpartum information gaps.ResultsHealth care providers, Internet-based resources, and mobile applications were common sources of health information during pregnancy. Mental and sexual health were the most common types of postpartum health information gaps. In bivariate analyses, higher income and education were associated with postpartum information gaps in mental health and sexual health, respectively (p < .05).ConclusionsPostpartum health information gaps were common in this sample, particularly for topics in mental and sexual health. Unexpected associations between higher levels of education and income and postpartum health information gaps were observed in bivariate analyses. Health educators have the opportunity to capitalize on high rates of Internet information seeking by providing health information online. Health care providers must incorporate mental and sexual health into routine postpartum care.     

基于智能手机的移动护理系统架构设计与应用分析简

本文介绍基于智能手机的病人移动护理的原型系统,该系统由四部分组成：病人信息管理;医嘱检查校验;护理执行记录;护理计划制订。系统提供了易于使用的数据输入人机界面接口,能够输出各种不同形式的护理记录;整个系统由手机客户端与移动支持中间件系统MSS（Mobile Support System）组成,MSS支持移动手机和医院信息系统之间的数据交换。该系统在医院临床实际应用中进行了试用,结果表明,移动护理系统能够把护士从日常繁琐的文书记录中解脱出来,其人机界面的友好性对应用效果有重要影响。     

推进城市社区卫生服务合理利用卫生资源

针对城市卫生服务体系改革与发展社区卫生服务,合理利用卫生资源,对盐城市社区卫生服务供需状况进行了系统的调查,对收集到的数据进行了分析和研究,并结合盐城市的实际情况,提出了相应的对策及建议。     

Building an Interprofessional Curriculum Framework for Health: A Paradigm for Health Function

There is an increasing call for curricula in health care to facilitate interprofessional client-centred evidence-based decision making through a reflective and reflexive framework. This discussion paper proposes that adoption of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) as a framework for curricula of health professionals promotes the necessary paradigm shift needed to legitimise a broad evidence base as the foundation of interprofessional dialogue. Client function is seen as the product of an open system incorporating the individual, social and environmental influences on behaviour, with the role of the professional being to acknowledge the context of individual behaviour through an understanding of individual’s functioning in their environment. It is concluded that client focused practice and an iterative process of clinical reasoning based on a broad evidence base that conceptualises health care as the maintenance and promotion of health across the lifespan requires a re-conceptualising of health. The emerging concept shifts the primary emphasis of health care away from post-diagnosis tertiary care towards clients who maintain a life-long independence in the community.     

社区卫生服务信息系统建设问题研究

随着信息化进程的推进,建设功能合理、方便快捷和综合性强的社区卫生服务信息系统已成为我国卫生事业发展的必然趋势。但在推进社区卫生服务信息化的过程中,尚有不少主观和客观因素阻碍其发展。基于系统的稳定性、扩展性、标准性、开放性和安全性等特征,分析社区卫生服务信息系统建设过程中的主要障碍并探讨相应的对策。政府、医疗卫生服务机构,相应的管理机构、信息技术提供机构以及社区居民应协调各方利益,共同建设社区卫生服务信息系统。     

手机与计算机之间的图像无线交互传输技术及其医学应用

研究了一种以手机为医学图像载体的辅助管理系统,实现针对个人的医学影像信息的存储、管理和健康信息的综合分析。文中讨论了以手机为核心的管理系统所涉及到的无线传输技术、手机在移动医疗中的技术能力和手机管理医学图像的方案．并以医用远红外图像的手机一计算机交互为例验证了此系统的可行性。     

3G移动通信在社区医疗的应用和发展

本文基于对未来社区医疗服务需求分析，并结合第三代移动通信（3G）技术，本着以人为本的服务理念，尝试把3G技术引入社区医疗信息系统，并对移动化社区医疗信息系统构建作了初步的探讨。     

Computerized information systems for social workers in health care

Social workers' contributions to preventive medicine; discharge planning; and effective integration of hospital, family, and community resources are becoming increasingly important within the changing context of health care delivery. Information technology can be a powerful tool for developing efficient, accurate, and comprehensive patient records. In spite of the potential that information technology offers health care social workers, the actual use of computerized patient data has been limited and slow to develop. This article describes the development of a prototype information system that supports the diverse tasks of health care social workers in ambulatory care, shows how a shared computerized database can improve coordination of patient care among multiple health care disciplines, and addresses emerging issues as a growing number of social workers in health care use computerized information systems.     

Reliability of Community Health Worker Collected Data for Planning and Policy in a Peri-Urban Area of Kisumu, Kenya

A general introduction of this article is as follows: Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009; Bradshaw et al. in initial burden of disease estimates for South Africa, 2000. South African Medical Research Council, Cape Town, 2003). The need for sound information is especially urgent in the case of emergent diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics (Aqil et al. in Health Policy Plan 24(3): 217–228, 2009). The government of Kenya, through the ministry of public health and sanitation has rolled out the community health strategy as a way of improving health care at the household level. This involves community health workers collecting health status data at the household level, which is then used for dialogue at all the levels to inform decisions and actions towards improvement in health status. A lot of health interventions have involved the community health workers in reaching out to the community, hence successfully implementing these health interventions. Large scale involvement of community health workers in government initiatives and most especially to collect health data for use in the health systems has been minimal due to the assumption that the data may not be useful to the government, because its quality is uncertain. It was therefore necessary that the validity and reliability of the data collected by community health workers be determined, and whether this kind of data can be used for planning and policy formulation for the communities from which it is collected. This would go a long way to settle speculation on whether the data collected by these workers is valid and reliable for use in determining the health status, its causes and distribution, of a community. Our general objective of this article is to investigate the validity and reliability of Community Based Information, and we deal with research question “What is the reliability of data collected at the Community level by Community health workers?”. The methods which we use to find an reliable answer to this question is “Ten percent of all households visited by CHWs for data collection were recollected by a technically trained team. Test/retest method was applied to the data to establish reliability. The Kappa score, sensitivity, specificity and positive predictive values were also used to measure reliability”. Finally our findings are as follows: Latrine availability and Antenatal care presented good correspondence between the two sets of data. This was also true for exclusive breast feeding indicator. Measles immunization coverage showed less consistency than the rest of the child health indicators. At last we conclude and recommend that CHWs can accurately and reliably collect household data which can be used for health decisions and actions especially in resource poor settings where other approaches to population based data are too expensive.     

Dynamic Integration of Mobile JXTA with Cloud Computing for Emergency Rural Public Health Care

ObjectivesThe existing processes of health care systems where data collection requires a great deal of labor with high-end tasks to retrieve and analyze information, are usually slow, tedious, and error prone, which restrains their clinical diagnostic and monitoring capabilities. Research is now focused on integrating cloud services with P2P JXTA to identify systematic dynamic process for emergency health care systems. The proposal is based on the concepts of a community cloud for preventative medicine, to help promote a healthy rural community. We investigate the approaches of patient health monitoring, emergency care, and an ambulance alert alarm (AAA) under mobile cloud-based telecare or community cloud controller systems.MethodsConsidering permanent mobile users, an efficient health promotion method is proposed. Experiments were conducted to verify the effectiveness of the method. The performance was evaluated from September 2011 to July 2012. A total of 1,856,454 cases were transported and referred to hospital, identified with health problems, and were monitored. We selected all the peer groups and the control server N₀ which controls N₁, N₂, and N₃ proxied peer groups. The hospital cloud controller maintains the database of the patients through a JXTA network.ResultsAmong 1,856,454 transported cases with beneficiaries of 1,712,877 cases there were 1,662,834 lives saved and 8,500 cases transported per day with 104,530 transported cases found to be registered in a JXTA network.ConclusionThe registered case histories were referred from the Hospital community cloud (HCC). SMS messages were sent from node N₀ to the relay peers which connected to the N₁, N₂, and N₃ nodes, controlled by the cloud controller through a JXTA network.